Basic Information
Provider Information
NPI: 1003802877
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GOMES
FirstName: JOSEPH
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: DO
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 10437 SW 53RD ST
Address2:  
City: COOPER CITY
State: FL
PostalCode: 333285607
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 1100 NW 95TH ST
Address2: EMERGENCY MEDICINE SPECIALISTS OF SOUTH FLORIDA
City: MIAMI
State: FL
PostalCode: 331502038
CountryCode: US
TelephoneNumber: 3058356191
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/27/2005
LastUpdateDate: 02/14/2008
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207P00000X0S8872FLY Allopathic & Osteopathic PhysiciansEmergency Medicine 

No ID Information.


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